Meniscal Allograft Replacement: Does it Work?
Meniscal Allograft Replacement: Does it Work?
Abstract & Commentary
Synopsis: This study demonstrates significant early to mid-term improvements in pain, function, and activity level following meniscal allograft replacement in properly selected individuals.
Source: Ryu RK, et al. Meniscal allograft replacement: A 1-year to 6-year experience. Arthroscopy. 2002;18(9):989-994.
The natural history of complete meniscectomy is well established. Total lateral meniscectomy in particular can result in rapid and relentless progression of arthrosis. What can be done about it? Well, as we all have learned, meniscal repair should be accomplished whenever possible and minimal meniscectomy when it is not. Nevertheless, total or near-total meniscectomy is an unfortunate consequence of certain knee injuries. When this occurs in very young patients, it can have devastating consequences. It seems reasonable, therefore, to consider meniscal replacement in this patient population—but how well does it work? This paper gives us some insight into this critical question.
This study evaluated the results of 29 meniscal replacements in 28 patients. Twenty-five patients with 26 meniscal replacements were evaluated at 1- to 6-year follow-up. Twenty-three allografts were evaluated with complete office evaluation and an additional 3 with telephone interviews. Study instruments included a visual analog scale, Lysholm II survey, Tegner and IKDC activity ratings, and a subjective scale. Results demonstrated that pain was significantly reduced and function was improved. Function improved in 17 out of 25, and overall satisfaction was 83%. Patients with grade IV chondrosis did worse, with functional improvement in only 3 out of 7. Workers’ compensation patients also fared worse. Combined ACL reconstruction, gender, and medial vs lateral replacement did not affect results.
Comment by Mark D. Miller, MD
Ryu and colleagues’ results are encouraging, especially in light of the fact that these patients have no other reasonable alternative. Ryu et al point out the flaws of their retrospective group without a control, but they have done an excellent job of following their cohort carefully. They describe their ideal candidate as younger than 45 years old with normal mechanical alignment, minimal (grade I or II) chondrosis, intact ACL, and some pain. Unfortunately, pain often heralds a knee in which arthrosis has progressed too far to make the patient a reasonable candidate for an allograft replacement; herein lies the dilemma. Additionally, it is still extremely difficult to get pre-authorization to perform these procedures in certain parts of the country and with certain carriers. Hopefully, with additional studies like the present one, and longer follow-up, we can turn this around.
Dr. Miller is Associate Professor UVA Health System, Department of Orthopaedic Surgery, Charlottesville, VA.
Synopsis: This study demonstrates significant early to mid-term improvements in pain, function, and activity level following meniscal allograft replacement in properly selected individuals.Subscribe Now for Access
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